Child-Pugh Score Calculator

What the Child-Pugh Score Measures

The Child-Pugh score grades the severity of cirrhosis using five parameters — two laboratory values that reflect synthetic liver function, one coagulation marker, and two clinical complications. Each parameter scores 1 to 3 points, so the total runs from 5 to 15 and maps onto three classes. It was developed to predict survival after portosystemic shunt surgery and remains in wide use as a bedside measure of hepatic reserve.

• Bilirubin — under 2 mg/dL = 1; 2–3 mg/dL = 2; over 3 mg/dL = 3
• Albumin — over 3.5 g/dL = 1; 2.8–3.5 g/dL = 2; under 2.8 g/dL = 3
• INR — under 1.7 = 1; 1.7–2.3 = 2; over 2.3 = 3 (prothrombin time prolongation is sometimes used instead)
• Ascites — none = 1; mild and controlled with diuretics = 2; moderate to severe or refractory = 3
• Encephalopathy — none = 1; grade 1–2 = 2; grade 3–4 = 3

Classes and What They Mean

• Class A (5–6): well-compensated disease. In the original cohorts, one-year survival was close to 100%.
• Class B (7–9): significant functional compromise, with classic one-year survival figures around 80%.
• Class C (10–15): decompensated disease, with classic one-year survival figures around 45%.

Those percentages come from small 1970s series and should be read as historical context rather than as a personal prognosis; contemporary survival is generally better and varies markedly with the cause of liver disease, the presence of complications such as variceal bleeding, and whether the underlying cause is being treated. Clinically, the class is used to communicate severity, to inform surgical and anaesthetic risk, to guide dosing of some drugs, and to shape decisions about treatments such as transjugular intrahepatic portosystemic shunting.

Child-Pugh Versus MELD

For many years Child-Pugh was the standard severity score. It has largely been displaced by the MELD score (and its sodium-adjusted variant) for allocating donor livers, because MELD uses only objective laboratory values, produces a continuous scale, and predicts short-term mortality more accurately. Child-Pugh nevertheless remains useful at the bedside because it is quick, requires no calculation tool beyond a table, and captures decompensating complications that laboratory values alone miss.

Limitations

• Ascites and encephalopathy are graded clinically, so two assessors can score the same patient differently. Inter-observer variation is the score’s weakest point.
• Albumin and bilirubin are affected by factors unrelated to liver function, including infusion of albumin, haemolysis, and Gilbert syndrome.
• INR is unreliable in people on anticoagulants and in those with cholestasis rather than hepatocellular disease.
• The score was not designed for acute liver failure, where different criteria (such as King’s College) apply.
• Thresholds for albumin, bilirubin and INR differ slightly between the original Child-Turcotte description and Pugh’s 1973 modification; local guidance should be followed.

Frequently Asked Questions